The word Root Canal Treatment itself usually makes the patients corelate it with pain and discomfort. This prevents them from visiting the dentist or an endodontist for further treatment and they keep postponing it and thus eventually end up causing more damage. The increased damage comes in forms of fever, swelling, pus formation, and severe pain. All this only because a simple Root Canal Treatment was avoided due fear and old stereotypes that it is painful. In this blog, we will discuss why such fear and stereotypes prevailed, how the current scenario is different and what advances have been made in terms of Root Canal Treatment or RCT. First, lets discuss why this fear and stereotype around a simple procedure. Well our teeth are mineralized structures from outside, but they contain nerves and blood vessels in form of pulpal tissue inside. It is when the decay or infection reaches this zone of pulpal tissue then the pain ensues. The older techniques involved use of hand filing systems with aggressive instrument designs to clean this space of infected tissue inside. Also overzealous use of various chemicals earlier lead to more tissue damage. This resulted in more inflammation and prolonged healing periods. Also multiple visits and appointments were required to complete the cleaning part after which the space was filled and sealed. Hence, this resulted in increased pain and discomfort. Also the local anesthesia techniques and instruments used were not advanced due to limited knowledge so the complete anesthesia was not achieved and so it was more painful earlier. Now lets discuss how it is different now. Currently, RCT is done primarily by using Endomotor or machined instruments which are less aggressive and faster. This leads to less inflammation and faster healing. Also the RCT can be completed in single or two visits at maximum. At present the concept of single visit RCT due to the technological advancements is predominant. However it depends on individual case whether single visit RCT can be done or not. The local anesthesia techniques now used involves thinner gauge needles, use of better solutions, and preinjection anesthetic jellys or spray to topically numb the surface. Also other advanced injection systems have also been introduced so the anesthesia itself is painless and complete anesthesia is acheived. Hence entire RCT is painless. What is single visit RCT ? The RCT is completed in one single appointment. So the pulpal canal space is opened, cleaned, disinfected and then dried and filled, all done in one single appointment. The patient does not need to come multiple times for the treatment. It is based on the concept that the newer generation instruments clean the canal effectively removing all bacteria and then irrigating solutions and postoperative antibiotics remove any bacteria which may remain. Also any bacteria in canal space will be entombed by the filling will not get its nutrition and will be eliminated. When can we do single visit RCT ? 1. When full mouth rehabilitations in which multiple teeth require RCT 2. 3. 4. 5. 6. 7. 8. Uncomplicated vital teeth in which the pulpal tissue has not necrosed Fractured teeth or teeth with accidental or mechanical exposure of pulp Patients in whom sedation is required Asymptomatic Nonvital teeth with sinus tracts Medically compromised patients Physically compromised patients who cant come to clinic multiple times Teeth with subgingival caries and multiple coronal walls missing where isolation is a concern When not to do single visit RCT ? 1. When patients have severe pain 2. 3. 4. 5. 6. 7. 8. 9. 10. When there are anatomic anomalies in the tooth Abscess with pus discharge cases Patients who cant keep mouth open for longer duration Teeth with limited access Symptomatic nonvital teeth with sinus tract Asymptomatic nonvital teeth without sinus tract or with periapical pathology Most retreatment cases Patient with allergies or history of flareups Hot tooth What are its advantages ? 1. Patient comfort as number of visits are reduced 2. 3. 4. Patient conveinance Reduced intraappointment pain Better restorations of the tooth The single visit RCT involves cleaning the pulpal tissue from top to bottom instead of bottom to top. This helps in preventing any extrusion of debris beyond the tooth below into the bone. This prevents any postoperative flare ups or pain. Also several instrument systems and newer NiTi f ile technologies have emerged so this helps in better preparation of the root canal space. The success of single visit RCT is more than 97% at present. At 32 PEARLS, we prefer for your comfort to do single visit RCT only whenever possible. So don't postpone your Root Canal Treatment as now it is painless and is done in single visit as most of the time now due to technological advancements it is possible.
